Dados do Trabalho

Título

ECOG AS A STRONGER PROGNOSTIC FACTOR THAN AGE OR CHARLSON COMORBIDITY SCORE IN > 75 YEARS PATIENTS WITH METASTATIC NON-SMALL CELL LUNG CANCER: A REAL-WORLD EXPERIENCE FROM A SINGLE CENTER

Introdução

Elderly patients (pts) are underrepresented in clinical trials. About 20% of patients with metastatic non small cell lung cancer (mNSCLC) are older than 75 years (y), and scarce information from randomized trials in this population impacts the decision-making process in clinical practice.

Objetivo

To assess the clinical characteristics and treatment outcomes in mNSCLC ≥75y treated at a cancer center.

Método

This retrospective study included 648 consecutive mNSCLC pts treated at a Brazilian cancer center from January 2007 to September 2020. Clinical-pathological data were collected from electronic medical records. Were defined the following age cut-offs: ≥75y versus <75y. Kaplan-Meier curves, Log-Rank test and Cox regression were used for survival analysis; Cox regression was used for univariate and multivariate analyses. Tests with p<0.05 were considered statistically significant.

Resultado

117/648 pts (18.1%) were ≥75y. In such pts, there were more ECOG ≥2 (31% vs. 11%, respectively; p<0.01) and more squamous cell carcinomas (24% vs. 16%, respectively; p<0.04) than in younger pts. Among the <75y pts, there were more Charlson comorbidity score ≥7 (57% vs. 28%, respectively; p<0.01) than in ≥75y. There were no differences in smoking status (smokers/former smokers: 71% in ≥75y vs. 68% in <75y; p=0.58), brain metastases (28% in ≥75y vs. 32% in <75y; p=0.53) and liver metastases (14% in both groups; p=1). Median follow up was 45 months (≥75y) and 31.9 months (<75y). Median overall survival (OS) was 15.8 months (m) in ≥75y and 20.2m in <75y (HR 0.28; 95%CI 1.0-1.6; p=0.045). Age ≥75y did not result in worst outcomes with chemotherapy (HR 1.1; CI95% 0.75-1.6; p=0.6), immunotherapy (HR 1.0; CI95% 0.54-1.86; p=1) or TKIs (HR 1.58; CI95% 0.96-2.6; p=0.07). Cox multiple regression analysis including age, ECOG and Charlson revealed ECOG as the strongest prognostic factor (HR 0.38; 95% CI 0.29-0.50; p<0.001).

Conclusão

Treatment outcomes in pts ≥75y were comparable to outcomes in younger pts (<75y). The results suggest that ECOG is a stronger prognostic factor than the age per se or Charlson comorbidity score in ≥75y pts.

Palavras-chave

Metastatic non-small cell lung cancer; Elderly patients; Prognostic factors